What is OHIP billing code D016?

D016 is "Glenohumeral joint - closed reduction with anaesthetic", an OHIP Orthopaedic Surgery code from the Ontario Schedule of Benefits (Physician Services).

How much does D016 pay?

The current OHIP fee for D016 is $111.40, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill D016 to OHIP?

D016 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates D016 claims against the Schedule of Benefits rules before submission.

What codes are related to D016?

Codes related to D016 in the Schedule of Benefits include D015, D017, R472, R401, E058.

All codes

D016

D016 – Glenohumeral joint - closed reduction with anaesthetic

OHIP Orthopaedic Surgery Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits

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This service covers the closed reduction of a dislocated glenohumeral (shoulder) joint. It is a manipulative procedure performed to restore the normal alignment of the joint, and is rendered with the patient under anaesthesia. The service includes the pre-procedural preparation, the reduction procedure itself, and immediate post-procedural care. As a surgical service, payment varies based on the role of the physician: surgeon (suffix A), surgical assistant (suffix B), or anaesthesiologist (suffix C).

When to Use

Use D016 when performing a closed reduction of a dislocated glenohumeral joint specifically requiring anaesthesia, distinguishing it from D015 which applies to reductions performed without anaesthesia.
Use D016 for the primary surgeon (suffix A) when the procedure is performed in a hospital setting under procedural sedation or general anaesthesia.

Common Pitfalls

Billing D016 without documenting the administration of anaesthesia, which is a mandatory requirement for this specific code.
Attempting to bill the Trauma Premium (E420) without explicitly documenting the Injury Severity Score (ISS) in the patient record, leading to automatic claim rejection.
Incorrectly billing D016 when the reduction is performed in an office setting without formal anaesthetic support, where D015 is the appropriate code.

Billing Tips

Ensure the anaesthesiologist (suffix C) and surgical assistant (suffix B) bill their respective services on the same claim as the primary surgeon to ensure all components are processed together.
If the procedure occurs after hours, ensure the correct premium (E409 or E410) is applied to the surgeon's fee, noting that these cannot be combined with the Trauma Premium (E420).

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Provider Fee$111.40

Anaesthetist Fee$92.94

Non-Anaesthetist Fee$92.94

Effective: April 1, 2025

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